Individual
MRS. JONELLA RENEE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
1000 CENTRAL ST, SUITE 101, EVANSTON, IL 60201-1777
(847) 570-1260
Mailing address
1503 MADISON STREET, EVANSTON, IL 60202
(847) 864-5740
Taxonomy
Speciality
Code
Description
License number
State
2251N0400X
Neurology Physical Therapist
Primary
070005649
IL
Other
Enumeration date
04/05/2010
Last updated
04/05/2010
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